Short Steroid Bursts Tied to Serious Adverse Events in Diabetes

For people with type 2 diabetes, short-term bursts of oral corticosteroids (OCS) were linked to certain health risks beyond steroid-induced hyperglycemia in a cohort study.

In a self-controlled case series of 36,048 patients, oral corticosteroid bursts — defined as continuous use for 14 days or less — were associated with increased risks of the following serious adverse events within 6 to 30 days compared with a baseline period:

• Pneumonia: incidence rate ratio (IRR) 2.06, 95% CI 1.65-2.57
• Heart failure: IRR 1.87, 95% CI 1.27-2.77
• Gastrointestinal tract bleeding: IRR 1.71, 95% CI 1.52-1.94

There were also signals of elevated 30-day risks for sepsis (IRR 1.57, 95% CI 1.00-2.48) and fracture (IRR 1.30, 95% CI 1.03-1.65).

“The excess risks were most pronounced within the first 30 days following OCS burst initiation,” wrote Tsung-Chieh Yao, MD, PhD, of Chang Gung Memorial Hospital in Taiwan, and colleagues in JAMA Network Open.

From days 31 to 90 post-initiation, elevated risks were observed for fracture (IRR 1.42, 95% CI 1.21-1.68) and gastrointestinal tract bleeding (IRR 1.26, 95% CI 1.14-1.38).

“From a clinical perspective, these findings underscore the importance of judicious OCS prescribing in patients with type 2 diabetes, particularly for self-limited conditions for which alternative therapies are available,” the authors noted. While generally perceived as low risk, oral corticosteroid bursts “may contribute meaningfully to morbidity in this high-risk population,” they added.

Clinical guidelines recommend close monitoring of blood glucose levels when initiating oral corticosteroid therapy in patients with type 2 diabetes, as steroids disrupt glycemic control. However, secondary risks beyond hyperglycemia have been less clear.

“Our findings extend prior work by demonstrating that patients with type 2 diabetes, who have elevated baseline risks for infection, cardiovascular events, and fracture, experience vulnerability to serious adverse events of OCS bursts,” the researchers wrote.

Yao’s team previously documented similar associations between oral corticosteroid bursts and adverse events in the general population. “We corroborate and extend these findings by focusing on patients with type 2 diabetes, highlighting that the safety concerns associated with OCS bursts extend to this vulnerable population,” the group wrote.

Using data from Taiwan’s National Health Insurance Research Database (2008-2022), the researchers identified eligible adults with type 2 diabetes who received oral corticosteroid bursts (mean duration 4.5 days). The cohort had a mean age of 61.6 years, and 52.4% were women.

The most common corticosteroid prescribing specialties were family practice (24.1%), dermatology (22.5%), internal medicine (15.9%), and otolaryngology (13%).

Results remained consistent across multiple sensitivity analyses, including corticosteroid burst definitions up to 30 days, exclusion of death events, and alternative washout windows. No significant association was observed for the negative control outcome of syncope.

Limitations acknowledged by the authors included an inability to verify patient medication adherence, a lack of lifestyle data in the registry, and potential limits on generalizability to non-Asian populations.